§ 28-33-34.1 - Schedule of medical review.
SECTION 28-33-34.1
§ 28-33-34.1 Schedule of medical review.– (a) On or about twenty-six (26) weeks from the date of a compensable injury,any person obtaining incapacity benefits shall be examined and their diagnosisand treatment reviewed by a comprehensive independent health care review teamor an impartial medical examiner. The comprehensive independent health carereview team or impartial medical examiner shall be selected through a mechanismto be established by the administrator of the medical advisory board. Theresults of the examination and review shall be provided to the employee and theinsurer or self-insured employer within fourteen (14) days of the examinationand a copy shall be filed with the medical advisory board. The comprehensiveindependent health care review team and/or impartial medical examiner shallreview the treating physician's findings and diagnosis and make its ownfindings of the extent and nature of the claimed disability, the degree offunctional impairment and/or disability, the expectation of further medicalimprovement, any further medical care, treatment, and/or rehabilitationservices that may be required to reach maximum medical improvement, type(s) ofwork that can be performed within existing physical capacity, the degree ofdisability expected at maximum medical improvement, whether the employee canreturn to the former position of employment, and compliance of the treatingphysician with protocols and standards of medical care established by themedical advisory board. The report shall be admissible as the court's exhibit.A party may be permitted to cross-examine the author(s) of the report withleave of the court.
(b) On or about thirteen (13) weeks after any examinationunder this section or § 28-33-35, a comprehensive independent health carereview team or impartial medical examiner shall perform a similar review. Thesame comprehensive independent health care review team or impartial medicalexaminer may not perform more than two (2) consecutive reviews on a particularemployee.
(c) The medical reviews required by this section may besatisfied by summary review if:
(1) The employee is receiving benefits for total incapacity,and the employee's condition is so severe or permanent that examination andreview is clearly inappropriate or unnecessary;
(2) The employee's return to work or a suspension of benefitsfor other reasons is imminent;
(3) The employee is under and following a rehabilitationprogram approved by the director of labor and training;
(4) The employee's condition has been previously reviewed bythe attending physician, comprehensive independent health care review team, orimpartial medical examiner, or in an approved rehabilitation program report,and was then determined to be and remains stable and at maximum medicalimprovement, and the employee has had an earnings capacity adjustmentappropriate to his or her present level of earnings capacity; or
(5) The employee is receiving weekly compensation benefitsfrom a self-insured employer that has filed and received approval of a requestfor exemption from the provisions of this section.
(d) Failure to appear for examination under this sectionshall be grounds for suspension or termination of benefits unless justified bygood cause. Residence outside the state does not, by itself, constitute goodcause for failure to appear.